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For Immediate Release: December 19, 2012
Association of Community Cancer Centers Releases Study on End-Stage Prostate Disease Outcomes and Decision Aids
ROCKVILLE, Md.—The Association of Community Cancer Centers (ACCC) has released a new study on quality outcomes for end-stage prostate disease and an assessment of patient education materials and decision-making tools. Findings suggest that many cancer programs are not collecting sufficient outcomes data to assess the quality of the care they provide to patients with metastatic or advanced prostate cancer. The study also found that few practical tools exist to measure progress or effectiveness of the prostate-specific cancer service line.
“ACCC’s study of prostate cancer programs is designed to give cancer programs the data and tools they need to improve prostate patient outcomes and satisfaction,” said ACCC President George Kovach, MD. “We hope that the benchmarks identified in this study will help cancer programs better understand and more clearly map their prostate program’s performance.”
As part of its educational project, “Prostate Cancer Programs: Developing Tools and Measuring Effectiveness in the Community Setting,” ACCC identified both clinical and non-clinical criteria for measuring outcomes that indicate success in treating patients with metastatic or advanced prostate cancer. Among the criteria identified were days from diagnosis to androgen deprivation treatment (ADT), time from first ADT to first chemotherapy, cumulative exposure to ADT (in months), coordination of services, referrals, patient and family education, patient satisfaction, use of patient navigation services and/or financial counseling, and referral to palliative care, social services, rehabilitation, nutrition counseling, and support groups.
Nine cancer programs submitted outcome data from their cancer registries for their patients with metastatic or advanced prostate cancer. Patients in these programs were identified as those with selection criterion 1) biochemically recurrent prostate cancer (those patients who have a rising PSA after local treatment, with or without evidence that the disease has spread to bone or other organs), selection criterion 2) metastatic prostate cancer (those patients who are diagnosed with metastatic disease at the onset), or selection criterion 3) both qualifying criteria.
This study was intended to begin to describe patterns of outcomes associated with different courses of treatment. Analysis of the data showed no differences in survival based on the way these patients with advanced prostate disease were managed with respect to use of chemotherapy or ADT only. Patients who received ADT had similar duration of survival to those who did not receive ADT on the whole. However, analysis of data reveals the following observations:
- With or without ADT patients who met both selection criteria 1 and 2 experienced shorter duration of survival.
- For patients without ADT, those who met selection criterion 2 tended to have longer duration of survival.
- For patients with ADT, those who met selection criterion 1 had longer duration of survival than those who met criterion 2.
The study included 175 patients who met at least one of the selection criteria.
Use of patient navigation services and financial counseling as well as referrals to social services, rehabilitation, nutrition counseling, and support groups were surprisingly low for all patients in the study and may reflect inadequate processes for tracking the use of these services.
During the course of the project, study leaders encouraged participating sites to examine their electronic medical record systems and processes for data capture and look for ways to improve intake of information from referral sources.
“Prior to beginning work with the ACCC project, our comprehensive prostate program had not formally measured outcomes data,” said Dorothy R. Carvalho, RN, OCN, of Middlesex Hospital Cancer Center in Middlesex, Conn., a site that participated in the assessment and educational program.
Through ACCC's project, Carvalho and her team developed a protocol for treatment of erectile dysfunction in prostate cancer patients, from baseline though treatment and beyond. Care for this group of patients became more standardized, and Middlesex Hospital Cancer Center was better able to address the different needs of men post prostatectomy, post radiation therapy, or currently on androgen deprivation therapy.
As part of this study, ACCC examined a number of patient education materials and decision-making tools to assess their usefulness during treatment of metastatic or advanced prostate cancer. Patient decision tools provide information on the options and help patients clarify and communicate the personal value they associate with different features of the options. One tool was the EPIC-16 CP (Expanded Prostate Cancer Index Composite for Clinical Practice), a comprehensive instrument designed to evaluate patient function and quality of life after prostate cancer treatment. The 16-question index assesses urinary, bowel, sexual, and hormonal function.
Findings from ACCC’s study show that the EPIC-16 CP was used across the variety of small and large centers and practices with their advanced prostate cancer patients. Some participating sites implemented EPIC-16 CP with early-stage disease patients as well. While urologists most often utilized the tool, a wide variety of other healthcare professionals involved in advanced prostate cancer patient care also successfully implemented the tool. Users overwhelmingly found the tool to be practical, efficient, and easy to implement in clinical practice with little to no adaptation. The tool provided useful information about prostate cancer patients’ quality of life that could be evaluated and meaningfully contribute to treatment decision-making for this population.
Some sites found additional tools useful, such as prostate cancer educational materials and decision guides, in conjunction with the EPIC-16 CP to facilitate patient understanding and treatment decision-making processes.
ACCC plans to collect data at additional cancer programs, conduct training at participating sites on strategies to enhance data collection for supportive services, and further its efforts to educate the oncology community about decision-making tools for patients with advanced prostate disease. ACCC hopes to form a Prostate Education Project Team consisting of 10 community cancer centers and supported by on-line forums and resources.